The report covers developments in e-portfolios, digital repositories,ubiquitous computing and informal learning. The discussions set out show concerns about status and valorisation of knowledge, disciplines and roles. Repository discussions touch on quality and gate keeping, portfolio discussions touch on the ownership of identity as a learner, while ubiquitous computing and informal learning touches on fundamental questions of access and learner control.

Saturday, November 26, 2005

Comments on Transformational Government

Comments on Transformational Government : Enabled by Technology

This document was published by the Cabinet Office in November 2005 based on research undertaken for the Chief Information Officers (CIO) Council, drawing on the experiences of CIOs and IT professionals in central and local government; Industry and technology specialists.

Comments are requested by Friday 3rd Feb 2006

My comments are based largely on my experience of IT in the NHS as this is the area I am most familiar with, however I think some of the principles apply across the public sector. Initially I give some general comments and then comment in more detail on a selection of paragraphs (paragraph numbering is taken from the original document which is available from http://www.cio.gov.uk/transformational_government/strategy/

A typo on the contents page: http://www.cio.gov.uk/transformational_government/strategy/contents/ which misses out the “S” from Transformational doesn’t help confidence in the technical accuracy.

The document sets out a vision for the future of public sector services which has a lot to recommend it, however it also raised some worries in my mind about the potential risks.

In my opinion the changes which are occurring, and will be increased by this strategy, in the relationship between the state and the citizen (or customer as members of the general public are largely called in this document). In addition I believe the strategy will change the balance of power between the CIO Council and ministers and departments with increasing power being vested in No 10 Downing Street and unelected officers.

The document rightly emphasises the potential benefits for individuals interacting with government at all levels eg less duplication, however this must be balanced with the risk of loss of control over personal information – highlighting the advantages and disadvantages of information sharing. A less explicit risk is the potential to increase the divide between the “information haves” and the “information have not’s”, which closely resembles the divisions within society between those with least money, the elderly and those for whom English is not their first language receiving the poorest services.

The vision set out includes collaboration between central and local government and a range of public sector bodies, however the recent announcement that no agreement could be reached, between the Ordnance Survey, Post Office and local Government about a standardised way of identifying each building (see http://society.guardian.co.uk/e-public/story/0,13927,1648128,00.html ) what hope is there for the much more complex agenda set out in this document?

Current IT spend is described as £14 billion per annum and it is claimed that savings will be made on this budget – but no timescale for these is given.

The attempts to systematically engage with citizens… to understand and then specify the changes needed and appoint “customer group directors” to lead the design of these services – however it appears that this consultation will be an extension of the already criticised “focus group culture”.

Some of the issues which appear from reading between the lines include:

The removal of the human face of government

Contracting out of large parts of the civil service

Political advisers rather than permanent secretaries

Some comments on language

I am always interested in the language used in these sorts of documents and the changes in the way in which issues are discussed. I particularly spotted a few phrases;“Technology for government”.“Doing IT better” moving to “doing IT differently” which I found reminiscent of an advert “work smarter not harder”.CHOICE (The C word) – finding out what the “customer” wants – however many of them may not be able to define this.“Co-branded solutions with major search engines” – are we moving to “Google.gov”?

So this strategy's vision is about better using technology to deliver public services and policy outcomes that have an impact on citizens' daily lives: through greater choice and personalisation, delivering better public services, such as health, education and pensions; benefiting communities by reducing burdens on front line staff and giving them the tools to help break cycles of crime and deprivation; and improving the economy through better regulation and leaner government.

Surely better regulation is not achieved through technology, although it may assist regulation is a function of government and depends on social and moral principles.

The specific opportunities lie in improving transactional services (eg tax and benefits), in helping front line public servants to be more effective (eg doctors, nurses, police and teachers), in supporting effective policy outcomes (eg in joined-up, multi-agency approaches to offender management and domestic violence), in reforming the corporate services and infrastructure which government uses behind the scenes, and in taking swifter advantage of the latest technologies developed for the wider market.

Uptake is by no means guaranteed, and adoption of services can prove to be a major hurdle in technology implementation as has been seen in the NHS National Programme for IT. There is a potential to increase rather than reduce social divisions.

8. Overall this technology-enabled transformation will help ensure that:

Citizens and businesses have choice and personalisation in their interactions with government. Choice will come through new channels and more fundamentally through new opportunities for service competition.

I wonder what “service competition” means in this context?

Citizens feel more engaged with the processes of democratic government.

Is there any evidence that increased use of technology make citizens “feel more engaged with the processes of democratic government.”Current Position

Modern government - both in policy making and in service delivery - relies on accurate and timely information about citizens, businesses, animals and assets. Information sharing, management of identity and of geographical information, and information assurance are therefore crucial.

The information sharing is notoriously difficult to achieve and where errors do occur, their effects can be magnified where that information is widely shared.

Yet many of these systems are also old and custom-built, use obsolete technologies, are relatively costly to maintain by modern standards, and hence stretch the capability of the whole technology industry when it comes to amending or replacing them.

However the used of “standard/off the shelf” software solutions can increase the power of a limited number of small players in the market and stifle innovation and the opportunities for SME’s to get a foothold.14. Moreover they increasingly fail to meet the needs of modern government and the rising expectations of customers:

Many systems and processes are still paper-based and staff-intensive. The underlying assumption is that customers will fill in forms and that staff will process them by routine rather than by risk-managed exception. Telephone access, customer access over the web and other improvements have sometimes been grafted onto this base. This locks in high costs and difficulty in meeting changing customer or policy requirements. Choice is costly and slow to implement.

The identification and scoping of risk is complex and greater emphasis seems to be placed on financial risk than human risk. EG in the NHS what level of saving balances the risk of death?

Many systems are structured around the "product" or the underlying legislation rather than the customer (sometimes because, at the time, each system was big or difficult enough to do by itself). Often the customer experience is not joined up, especially when it crosses organisational boundaries.

Is choice necessarily what the population wants? Examples of the changes to the specification of an electronic booking service to “Choose & Book” in the NHS to provide choice which most patients don’t want doesn’t bode well.

Many systems were designed as islands, with their own data, infrastructure and security and identity procedures. This means that it is difficult to work with other parts of government or the voluntary and community sector to leverage each other’s capabilities and delivery channels. It also leads to customer frustration, duplication of effort (for instance on customer change of address) and failure to make timely interventions, as the Bichard Inquiry showed. Choice requires services to be able to talk to each other.

But may provide protection against inappropriate use of personal information and systems failures.18. Since then the Government has taken a consistent approach to improving performance in such projects. In the last five years progress has been made towards addressing some of these issues:

..

Use of the internet: Responding to the Prime Minister's challenge, over 96% of government services will be "e-enabled" by the end of 2005. Over half of households have the internet at home, and broadband is available to almost all homes and businesses. There are also 6000 UK Online centres in place, providing internet access and free assistance to those who do not wish to go online at home.

Despite these impressive sounding figures, uptake and use by the general population has been much more limited.Citizen and Business Centred Services(a) Systematically engage with citizens, business and front-line public servants to understand and then specify the transformational changes which service providers need to meet - learning from the best practice already within the public sector, from other governments and from the private sector.23. For public services the Prime Minister has set out clear principles of reform - national standards, devolution of delivery, flexibility in service provision and greater customer choice. Basing services on what the customer wants and needs is crucial to technology-enabled public service transformation. Some parts of the public sector have developed mechanisms for measuring customer response to particular services. However customer insight and market intelligence is not shared systematically across government. Unlike some other national governments, the UK has no regular, holistic and publicised assessment of customers and their experience of public services. To modernise services government needs a systematic view of what citizens, businesses and front line staff want and need.I’m not sure what this means, I feel that greater clarity is needed about “wants” and “needs” and how these are to ascertained. Do “customers” know what they want – despite rhetoric about a patient led NHS few are actively involved in this process. It is likely that advantaged articulate groups will participate in consultations and express their wants, however the needs of disadvantaged groups are much more difficult to collect.25. The needs of key groups - such as older people - are best viewed in the round rather than service by service. So part of this work will be to help define the customer groups. These are where citizens or businesses expect, or where social and policy outcomes require, joined-up and consistent presentation, access to and delivery of all relevant government services. This will be a complex picture: people rarely fall neatly into categories, so services needs to be responsive enough to deal with the fact that individuals often associate themselves with different groups at different times depending on their particular need.This is an extremely complex process as has already been seen in trying to safely share information at the boundaries between health and social care. No mention is made of how the conflicting needs of different groups eg the elderly and new mums will be prioritised.(b) Appoint "Customer Group Directors" for particular groups of the citizen/business population to lead the design of services, working to Ministerial leadership.28. These appointments should normally be people already leading a major service line, and each Customer Group Director would create a "Customer Group Team" from the key public and voluntary sector bodies which serve the customer group and from the relevant marketing, research and communication groups.This strikes me as moving the deckchairs, with new titles and badges – although relevant experience and qualifications and experience are important some in key positions may provide barriers rather than drivers for change.(c) Create a Service Transformation Board whose role is to set overarching service design principles, promote best practice, signpost the potential from technology futures and challenge inconsistency with agreed standards29. In order to steer and co-ordinate the work of Customer Group Directors and others, the Government will set up a Service Transformation Board of officials from the wider public sector who run major services and have operational delivery responsibility. The Cabinet Office will provide the secretariat and design authority for the Board under a Service Transformation Director.It is unclear where the poser and responsibility will lie. Will the Customer Group Directors and Service Transformation Board finally get us to the Ministry of Administrative Affairs envisaged in Yes Minister many years ago?33. To improve efficiency, effectiveness and customer value, action is required to improve government's use of these channels, including:

There are currently over 2500 government websites. To ensure that overall the government uses the web most effectively to support its service delivery and communications strategies, the web presence of government will be rationalised. For each government organisation the number of different web sites it uses will be reduced and consistency introduced in line with its overall communications strategy. For customer information, self-service transactions and campaign support, services will converge on DirectGov and Business Link as the primary on-line entry points; service-specific or stand-alone solutions will be phased out.

The menu, search and navigation will be vital if people are to identify the information and “transactional services” they need

Improvement in the use of search to access the government's web information, including exploring the potential for co-branded solutions with major search providers. This will learn from the way people now use the wider internet.

Google.gov !!! 7Giving citizens online access to their records and data held by government, mirroring existing rights and reducing the cost of handling simple enquiries.If NHS Connecting for Health has been unable to provide the “sealed envelope” for sensitive and personal health information in the initial release of the National Care Records System (NCRS), then I hope other areas will have more success.39. A new Shared Services approach is needed to release efficiencies across the system and support delivery more focussed on customer needs. Technology now makes this far easier than ever before. Shared services provide public service organisations with the opportunity to reduce waste and inefficiency by re-using assets and sharing investments with others. Tackling this will be a major challenge as government prepares for the 2007 Comprehensive Spending Review. Particular attention should be paid to the following areas:

Data Sharing: data sharing is integral to transforming services and reducing administrative burdens on citizens and businesses. But privacy rights and public trust must be retained. There will be a new Ministerial focus on finding and communicating a balance between maintaining the privacy of the individual and delivering more efficient, higher quality services with minimal bureaucracy.

Previous government approaches appear to have been towards minimal bureaucracy rather than privacy and public trust.5. Information Management: to facilitate the move towards more collaborative working on issues that involve a range of government organisations, common standards and practices for information management will be developed, with an effective range of tools to allow the most efficient use and sharing of information to all those across government that have a legitimate need to see and use it.Surely the big question is who decides what is a “legitimate need”?6)Information Assurance: despite the difficulties of a fast moving and hostile world, underpinning IT systems must be secure and convenient for those intended to use them. The Government will further develop its risk management model to provide guidance on this, approved by the Central Sponsor for Information Assurance. And it will develop a simple, tiered architecture for its own networks to support this model in practice, with an updated application of the protective marking scheme for electronically held information. Government will also play its part to promote public confidence by leading a public/private campaign on internet safety and by a new scheme to deliver a wider availability of assured products and services.

I wonder how the role of “Central Sponsor for Information Assurance” links to the Information Commissioner and the like. Will Shibbolith provide this functionaility?

7)Identity Management: Government will create an holistic approach to identity management, based on a suite of identity management solutions that enable the public and private sectors to manage risk and provide cost-effective services trusted by customers and stakeholders. These will rationalise electronic gateways and citizen and business record numbers. They will converge towards biometric identity cards and the National Identity Register. This approach will also consider the practical and legal issues of making wider use of the national insurance number to index citizen records as a transition path towards an identity card.

This is another minefield. The National Insurance Number is only issued to 16 year olds therefore excluding children. Where does the new format NHS number which has been issued over the last few years fit into this picture?

Professionalism

Government's ambition for technology enabled change is challenging but achievable provided it is accompanied by a step-change in the professionalism with which it is delivered. This requires: coherent, joined up leadership and governance; portfolio management of the technology programmes; development of IT professionalism and skills; strengthening of the controls and support to ensure reliable project delivery; improvements in supplier management; and a systematic focus on innovation.

I would welcome moves to increase professionalism within the IT industry and would suggest that education and regulation are both important here. Within the health informatics field UKCHIP (http://www.ukchip.org/ ) is leading the way.Leadership and Governance

Coherent, joined-up leadership and governance across government are essential to ensure the vision and programmes set out in this strategy are achieved and that the opportunities for technology to enable change continue to be identified, communicated, managed and delivered effectively. Complex reform requires consistent pressure to be applied across the whole system for a number of years. Leadership needs to be provided at several levels - by Ministers and Councillors; by Heads of Department and equivalents; by business leaders across the public sector; by CIOs; and by industry leaders - and aligned with the wider governance of the public services. An open and transparent approach to plans and performance is essential.

The open and transparent approach has not been a feature of the NPfIT, in which the barriers of commercial confidentiality has been one of the major criticisms by those who need to use the systems and carry through the change management envisaged.It would be interesting to see an attempt at a mapping of the information needs by sector, citizen groups, business groups etc.I found the statement on the final page when asking for comments indicative of the direction of travel.:An automatic confidentiality disclaimer generated by your IT system will not, of itself, be regarded as binding on the Department.

Second Annual CRDB Stakeholder conference - a personal report

The following post provides some purely personal, selective and idiosyncratic reflections on the Second Annual CRDB Stakeholder conference, held at the Business Design Centre, London, on 24 November, 2005 (http://www.connectingforhealth.nhs.uk/crdb). It does not reflect the views of any group or organisation with which I may be associated. So, after that introduction, it probably does not take a genius to work out that I will not have too many positive things to say about the event.

I did come away with one or two useful bits of information, but on the whole, I felt that the event was not the most useful way of spending the day. The event was summed up for me by the comment from one member of the audience who, in pointing out that the chest X-ray on the back of the glossy conference folder was the wrong way round, suggested that 'if they can't even get that right....' (fill in the rest yourself). It was also extremely disappointing that neither of the nursing Clinical Leads, not the nurse on the CRDB Board, were at the event (although to give Barbara Stuttle due credit, she did provide a short AV presentation), and so we were not able to find out anything about what is happening as far as engagement with the largest part of the NHS workforce.

The freebie 64MB USB drive that came with the conference folder will come in useful - although, even though I am a gadget junkie, I cannot really see why every attendee needed one of these when all it contained was a couple of PDF files of documents we already had in paper form. Despite the attempts to show 'how much progress we've made in the past year', I felt the event was one of 'marking time' and only held because it had been promised. I did not come away with much new information, and the breakout sessions seemed to be exploring the same questions we have been exploring since the first versions of the ICRS came out for discussion. As I heard other people also say, why are we still exploring the same questions (even if they are important) and what does this say for overall progress? On an admittedly small sample, other people I spoke with were also rather disappointed by the event. So, if you have different views, please add them in a comment below.

Oh, and the one thing that I did find interesting and positive (and had confirmed by two people that I had heard correctly) was that patients will (eventually, once everything is in place) be able to use NHS Healthspace to view the audit trail of who has accessed and done what with their clinical record. That will be a very useful deterrent to dealing with much of the unauthorised access to records that we know goes on at present, and that could otherwise occur in the future.

Patient Opinion - Social Networking site

I recently came accross this site "Patient Opinion" founded by Paul Hodgkin, a doctor who wanted to find a way to make the wisdom of patients available to the NHS.

"Patient Opinion is a new service that tells you what other people are saying about your local health services and lets you share your story with others"

It has been set up as a social enterprise - an independent company, but is run for a social good — in this case, for the benefit of patients and the NHS.

They hope to get income from providing reports to health care providers on what patients are saying about their services, analysing and reporting the opinions and ratings from patients, and provide this information to health service managers and clinicans so that they can act on the views of patients and hopefully improve their services.

The service is still in Beta pilot and most of the hosptials and services mentioned are in the north of England, but I feel it has potential as a national service providing the opportunity for people to share their stories of their treatment etc and potentially provide feedback to healthcare providers, which takes into account the "lived experience" rather than the "bean counting" approach of some audit mechanisms. I wonder what will happen when a negative patient experience described on the site is picked up by the press and whether those who share their experience are aware of the additional trauma this can cause?

Thursday, November 24, 2005

Connecting With Nurses

A new document from Heather Tierney-Moore and Barbara Stuttle clinical leads for nursing within NHS Connecting for Health has been published on their web site identifying benefits for nurses and midwives from the implementation of the National Programme for IT, including;

While nurses will adopt different approaches to practices such as record-keeping, the focus will remain firmly on the delivery of consistent, high quality professional practice.

“Nurses will be able to electronically share information between teams and across acute and community boundaries, providing the fast efficient flow of information that patients would expect,” says Heather Tierney-Moore.

“They will no longer have to spend a large part of their day recording written information time and time again, chasing up results and trying to locate paperwork that has gone astray. It will all be done for them by the new technologies, freeing up more of their time for patients.

“And they won’t have to make endless telephone calls to arrange appointments and leave messages because the National Programme will give them a modern secure email system.”

In addition, it will provide decision-making tools that “will clearly and safely support rapidly changing practice,” says Barbara Stuttle.

“Evidence-based protocols will be set behind the electronic patient record so that when nurses enter a diagnosis, the computer will flag up a particular route of action for them to take. This will be particularly advantageous for newly qualified nurses or those working in unfamiliar areas.”

Each of the four major areas; electronic appointment booking (Choose and Book), an electronic care records service (the NHS CRS), a system for the electronic transmission of prescriptions (ETP) and a fast, reliable underlying IT infrastructure are considered.

Heather says: “As the biggest single professional group in the NHS, nurses, midwives and health visitors often understand better than anybody how information really flows through a hospital or community.

“It’s therefore vitally important that we get them involved in informing the design of new technology, to ensure we get workable systems.

“A lot of nurses working at grass roots level have not previously heard about NHS Connecting for Health and for them the new technology seems a long way off. Because many have limited access to IT, they are also concerned about getting adequate training to be able to cope when the new systems arrive."

“Then there are people at the other end of the scale who have a particular interest in health informatics and have actually put some systems in place themselves. These nurses are really worried that the National Progamme is too focused around hospital doctors and GPs and that the nursing voice isn’t being properly heard."

“We are working to get the message across to everyone that the only way forward is for them to get actively involved in asking questions, putting their ideas across and, if they haven’t already got it, equipping themselves with basic computer training in preparation.”

A second document sets out the need for engagement with the programme.

Lets hope that they will successful in their mission and that nurses will get actively involved in the implementation, and not see it as one more imposed change which makes their work harder rather than easier.

No sealed envelopes for first summary records

According to E-Health Insider an announcement was made, at the NHS Coonecting for Health Care Records Development Board Conference, that no ‘sealed envelope’ technology will be available for the very first release of the NHS Care Record Service next year.

There are some nebulous statements about still protecting patients rights over their own records and a Connecting for Health spokesman explained: “The approach will involve discussion between the patient and clinician about what they think appropriate to put on the shared record in the first instance.”

New digitisation report calls for cross-sectoral e-content strategy

A report published today, suggests that although around �130m of public money has been spent on the creation of digital content since the mid-1990s, public sector digitisation programmes have been unstructured, piecemeal and fragmented. In contrast, Google’s Print Library Project, which aims to digitise huge quantities of books from some of the world’s leading libraries, “portends a revolution” in the world of information provision in which the public sector risks being left behind. The report which was commissioned on behalf of JISC (Joint Information Systems Committee) and CURL (Consortium of Research Libraries in the British Isles) and based on research undertaken at Loughborough University, calls for “a dynamic response” from public sector organisations to meet these challenges and recommends the creation of a UK-wide strategy to avoid the duplication, gaps in provision and lack of coordination that have hampered public sector efforts in this area.

In spite of such findings, however, the report also points to the “phenomenal” growth in the “richly detailed and flexible material” that publicly-funded digitisation programmes have been responsible for in the last ten years. “Digital resources are now available to enrich educational experiences at all stages of the learning journey,” says the report, “from formalised lessons in the primary classroom to the lifelong learner’s casual browsing at home.”

In order to maximise continuing public sector investment in digitisation, however, the report recommends the setting up of a UK task force to set clear guidelines on standards and to coordinate a national e-content strategy. The development of a single point of access to the range of services, information sources and funding streams on offer would also, the report continues, bring much-needed coordination to national efforts. Finally, the report recommends that greater attention be paid to the needs of users, which, it says, “are still not fully understood.” Gaps in provision, such as those in science and the social sciences can be filled through consultation with the relevant scholarly, subject, professional and research bodies, the report concludes.

The complications of a botched operation

Another interesting piece by Michael Cross in today's Guardian in which he argues that trying to provide national access to any patients record wherever & whenever it is needed, rather than focusing on the much more common local information transactions, may "derail" the whole NPfIT in the NHS. He makes some interesting assertions and suggests that we "may see some significant "re-scoping" soon".

However his assertion about emergency practice is wrong: "When people are run over by buses out of town, accident and emergency medicine has evolved relatively effective ways of coping without information. When that information could save a life - that famous penicillin allergy, for example - the data is better conveyed in a piece of medical alert jewellery worn next to a pulse point."

Having spent approx 15 years working in and around A&E departments I can ssure him that the uptake of medicalert bracelets and similar jewlery is very low and, even when they are worn, they are often not up to date - and frequently less legible than a doctors handwriting! In addition the information which is relevant to the patient care, for example by a GP deputising service late at night, is often more complex than can be reported on a bracelet. The availability of medical history "out of town" is a strong selling point of the NPfIT and should not be belittled as it has the potential to make a real difference to those individuals at a time of high stress and potential danger.

A shock in store for government culture

Yesterday's Society Guardian carried an epublic suplement which was all very interesting, and I was particularly impressed with the article by Michael Cross "A shock in store for government culture" which provides a cogent description of the direction of travel for government/public sector IT in the UK.

A lot of the comment is based on Transformational Government - Enabled by Technology, released earlier this month by the governments' Chief Information Officers Council who highlight supporting strategic areas:
* Transformational Government – the strategy for using IT to transform government and to deliver modern public services more effectively
* Shared Services – how government and the wider public sector can achieve significant savings and increase effectiveness by modernising the provision of corporate services
* Government IT Profession – bringing together IT professionals to create a joined up, government-wide IT profession
* Delivering Success – providing improved leadership to IT enabled business change programmes, and development opportunities to IT professionals in the public sector

Examples are given in the article from the NHS National Programme for IT and the Criminal Justice System of current developments, suggesting government IT is getting better, and pushing for the removal of the "Silo culture" to provide joined up services. Some of the work required to achieve this including; encouraging citizens to use egovernment channels, routine sharing of personal data, electronic identity management and increased professionalism in the IT workforce, are touched on, but some of these may also turn out to be major barriers to future implementation.

Sunday, November 20, 2005

A strategic approach to developing e-learning capability for heathcare

This interesting article by Angie Clarke, Dina Lewis, Ian Colet & Liz Ringrose, published in the current edition of Health Information & Libraries Journal, (Vol 22, Issue s2, pp. 33-41) examines a strategic approach to developing e-learning capability to enhance learning opportunities for the workforce of a healthcare organization. Emphasis is given to the procurement of a bespoke Managed Learning Environment (MLE).

The process undertaken in the North and East Yorkshire and North Lincolnshire (NEYNL) Workforce Development Consortium (WDC) during a 2-year implementation is described and evaluated.

The authors conclude that "the healthcare MLE is offering enhanced learning opportunities and assisting area healthcare providers in training their dispersed workforces. Blended learning strategies are most successful. The need for protected time for e-learning is a key issue, financial savings are available. Progress has been slowed by identified organizational constraints—the MLE's benefits are widely recognized".

BCS Meeting - Sean Brennan on NPfIT

The meeting organised by the British Computer Society Nursing Specialist Group and Bristol Branch on Thurs Nov 17th 2005 at the University of the West of England, Bristol went very well. The picture shows John Gardner (sec BCS Bristol Branch -left), Richard Hayward (Chair Nursing Specialist Group - centre) & Sean Brennan (speaker) - right (c) Peter Murray

Approximately 80 people attended to hear Sean Brennan present a very humourous commentry on the use of Information Technology in the NHS, in particular how gaining the sign up/input of clinicians will assist new technology to deliver improved/timely care to patients.

Sean opened the presentation with the ironic perspective of how technology developed and used on farms for milking cows and in vetinary practice have helped to support the financial and business implications of the industry and practice.

Networks and hardware

Sean described how the new N3 network is fundamental in supporting all NPfIT projects, and that unless N3 delivers a robust and fast network, the effectiveness and benefits of technology delivered through the programme will not be realised. As an example, Sean suggested the new network must support rapid upload of image files such as PACS to ensure a positive clinical/end-user experience, not previously delivered through NHSnet. He demonstrated this by having a "downloading now - please wait graphic" depress the audience.

The internet and information quality

Sean shared a view of the internet as a resource capable of offering a library of both reliable and unreliable information. A focus on how EBay has boosted worldwide capitalism through customers buying from unknown suppliers led to observations on the importance and need for data integrity to ensure patient records are trustworthy and timely (aacompanied by the song "I bought it on ebay").

What clinicians want form NPfIT

Sean closed the presentation indicating the need for clinicians to be continually involved in NPfIT to support project success. Sean summarised; if systems delivered through the programme are to be used effectively, they (the systems) must have sign-up/input into the project at the highest level, including clinician input into the development/build and ongoing projects. Systems must be friendly to use, which enable a culture and ethos amongst staff to use the technology available, which is reliable, fast and sparing of limited clinical time in order to support patient care.

A bit about Sean

Sean Brennan started working in the NHS in the 1970's, originally as a Medical Laboratory Scientific Officer before becoming an Information Manager. In 1993 he was seconded to the Department of Health and became the project manager for the NHS's national Electronic Patient Record, then taking on policy roles in both English and Scottish Health Departments. In 2000 he joined a computer supplier and then launched Clinical Matrix Ltd, a consultancy company engaged in strategy development, business cases, and clinical change management.

Sean writes a monthly column 'Down at the EPR Arms' for the British Journal of Healthcare Computing & Information Management, and his new book, "The NHS IT Project: the biggest computer programme in the world... ever!", was published in April 2005 It provides a comprehensive and highly accessible examination of the past, present and possible future of NHS Computing. The present £6.2 billion National Programme for IT, provides some interesting challenges and new models for public sector IT.

The Health Report: 14 November 2005 - Healthcare Knowledge

Interesting transcript of a radio interview with Dr Muir Gray, Director of Clinical Knowledge for the British National Health Service, and Dr Enrico Coeira, Professor of Medical Informatics at the University of New South Wales. The interview by Norman Swan was broadcast on Monday 14 November 2005 and highlights some interesting issues.

Muir Gray: Knowledge is like water, clinicians and professionals and patients need clean clear water for good health. They also need clean clear knowledge. And we see the whole knowledge business like water - wherever you are you should be sure that the knowledge you're getting as a patient and the knowledge your doctor or nurse is getting is clean and clear.

Enrico Coeira: This is a very interesting issue, people think just by providing technology it's going to change behaviour and what we've found is that what determines the use of evidence in these hospitals has everything to do with the culture of the hospital. So, if there is a belief by the senior staff that looking up and finding out what the right thing to do is promulgated across the staff then people will do that. And in places where people think they know the answer then they won't do it. So providing the evidence and finding the web connection is great, it's certainly a necessary part of the story but we also are talking about culture change across the clinical professions.

Enrico Coeira: To actually do a good search on Medline you have to be a biomedical librarian. (!)

The whole article raises some interesting points about the quality of scientific knowledge, specifically related to the Cochrane Collaboration, peer review in the journals and the speed and format of information transmission. Some potential areas of rurther work and collaboration in information sharing between the UK and Australia.

Mobile technologies to give health students access to learning resources in the UK community setting

Interesting article in the latest edition of Health Information & Libraries Journal (22 (s2), 51-65. doi: 10.1111/j.1470-3327.2005.00615.x ) by, Graham Walton, Susan Childs & Elizabeth Blenkinsopp, which describes a project, using a literature review and questionnaires, to explore the potential for mobile technologies to give health students in the community access to learning resources (m-learning).

At the time of the review the most prevalent mobile technologies were PDAs, laptops, WAP phones and portable radios with use being concentrated around doctors in the acute sector. A range of advantages and disadvantages to the technology were discovered. Mobile technologies were mainly being used for clinical rather than learning applications. The students showed a low level of awareness of the technology but placed great importance to accessing learning resources from the community.

JMIR - What Is eHealth (5): A Research Agenda for eHealth Through Stakeholder Consultation and Policy Context Review

An interesting article by many of the UK's leading researchers in Health Informatics (Ray Jones, Ray Rogers, Jean Roberts, Lynne Callaghan, Laura Lindsey, John Campbell, Margaret Thorogood, Graham Wright, Nick Gaunt, Chris Hanks, Graham R Williamson) has just been published in the Journal of Medical Internet Research.

It describes work undertaken to explore the concerns of stakeholders and to review relevant policy in order to produce recommendations and a conceptual map of eHealth research.

Their conclusions were that "Stakeholders would like eHealth research to include outcomes such as improved health or quality of life, but such research may be long term while changes in information technology are rapid. Longer-term research questions need to be concerned with human behavior and our use of information, rather than particular technologies. In some cases, “modelling” longer-term costs and benefits (in terms of health) may be desirable."

Thursday, November 10, 2005

NHS England extend BioMed Central membership to 2008

BioMed Central an "open access publisher" has today announced that the agreement they have with NHS England has been renewed until March 2008.

The open access publishing model means that any published articles can be accessed in full text by anyone with internet access and the charges which would have been made for subscription to the journal are transferred to a charge for anyone submitting a paper for publication. Today's agreement means that there are no charges to individuals employed by the NHS for another 3 years.

It is interesting to take a look at the articles which have been published by NHS England staff over the last few years with BioMed Central journals. It shows that during 1999 there was only one, in 2000 there were four, and in subsequent years significantly more (2001 = 12, 2002 = 28, 2003 = 29, 2004 = 63 & during 2005 so far = 73), it is therefore likely that the signing of a deal between NHS England and BioMed Central in 2003 significantly increased the amount of publicly funded research in the NHS which was placed into the public domain.

A similar agreement is in place to enable researchers in HEFCE funded institutions to submit their papers to BioMed Central without fees thanks to an agreement with JISC - it is not possible to do a similar count for these publications as each university is listed separately on the web site. I understand that the JISC agreement expires in June 2006 and that discussions are currently underway about the possibility of extending this.

A slightly different model described as "quasi open access" has also been developed and I came across it the other day when getting a paper from the International Journal of Nursing Education Scholarship. This approach from The Berkeley Electronic Press as their response to the "Scholarly Communication Crisis" and enables users to download the full text - and then the publisher sends an email to hassle the institutional librarian to take out a subscription.

These are encouraging signs in a long running debate about how to make research, particularly that which is publicly funded, available to all, which has yet to reach it's final stages. The likely development of institutional repositories should stop a university for example, having to pay a subscription to a publisher to be able to read the work created by their own staff. The general direction of travel is towards a more open society in which patients and clients have the same level of access to knowledge sources as the "experts", and this should lead to a paradigm shift in which the professionals cease to be the gatekeepers to knowledge and become guides and interpreters helping their patients and client to understand the published literature and discuss, on a more equal footing, the significance for them and their own health.

Evidence in practice

Interesting piece in E-Health Insider (& local to me) from Sally Hernando Assistant Director of Quality (Knowledge Resources and e-Learning Strategies) , Avon, Gloucestershire and Wiltshire Workforce Development Confederation about the development of elearning materials to embed learning about NPfIT into the medical students curriculum.

They are currently recruiting members for an external reference group see: http://www.ubht.nhs.uk/evidence-in-practice/eip_elearning_courseware.htm

Effective e-learning for health professionals and students-barriers and their solutions. A systematic review of the literature-findings from the
HeXL project
Sue Childs, Elizabeth Blenkinsopp, Amanda Hall, Graham Walton

Wednesday, November 02, 2005

The ethics of research using electronic mail discussion groups

This interesting article by Debbie Kralik, Jim Warren, Kay Price, Tina Koch and Gino Pignone from the University of South Australia, has just been published in the Journal of Advanced Nursing, Vol 52, Issue 5, pp. 537-545.

The paper aims to identify and discuss the ethical considerations that have confronted and challenged the research team when researchers facilitate conversations using private electronic mail discussion lists as a collaborative data generation method.

The researchers experiences in the study have increased their awareness for ongoing ethical discussions about privacy, confidentiality, consent, accountability and openness underpinning research with human participants when generating data using an electronic mail discussion group. They describe how they worked at upholding these ethical principles focusing on informed consent, participant confidentiality and privacy, the participants as threats to themselves and one another, public-private confusion, employees with access, hackers and threats from the researchers.

They conclude that a variety of complex issues arise during cyberspace research that can make the application of traditional ethical standards troublesome, challenging traditional ethical definitions and calling into question some basic assumptions about identity and ones right to keep aspects of it confidential.

The use of electronic mailing lists (and asynchronous forums/bulletin boards, synchronous chat rooms etc) is still a novel research method, although growing in importance, and some of the lessons from these researchers are likely to be helpful to anyone else considering these methods. It is a significant contribution to the debates in this area.

Evaluation of conference blogs

We have devised a short evaluation questionnaire to get some views on the value and use of the health/nursing informatics blogs we developed during 2005. We provided blogs for the following conferences: HC2005, SINI2005, MIE2005. Before taking the work further in 2006, we want to get some views from the health/nursing informatics community.

If you have any questions - eg if anything is not clear - please email Peter Murray (peter@open-nurse.info). We also welcome any additional feedback on the blogs or the questionnaire. The questionnaire is not ideal, but a compromise between not being too long, and getting a good range of information.

The data gathered will be used for several purposes: to feed back to the conference organisers, to help us in making decisions on how best to develop blogs in the future; to develop papers and conference presentations about the issues. No respondent-indetificable data will be released.

SNOMED and NHS C4H Proposal for International Standards Development Organisation

Yesterday SNOMED® International, a Division of The College of American Pathologists (CAP) and NHS Connecting for Health, an Executive Agency of the Department of Health in England, announced a proposal to establish an international Standards Development Organization (SDO) to offer countries the opportunity to take a leading role in the development, ownership and maintenance of SNOMED Clinical Terms (SNOMED CT).

SNOMED CT is a standardised healthcare terminology including comprehensive coverage of diseases, clinical findings, therapies, procedures and outcomes which provides the core general terminology for the electronic health record (EHR) and contains more than 357,000 concepts with unique meanings and formal logic-based definitions organised into hierarchies.

I wonder if an international approach will overcome some of the problems which have been encountered when trying to combine the UK's Clinical Terms V3 (ex Reed Codes) with the US SNOMED system, and whether this standard will truely emerge as the worldwide nomencleture of healthcare?

Tuesday, November 01, 2005

PATH: Professional Assessment of Technology in Healthcare — PATH Portal

My colleague Dr Nikki Shaw has just sent me the 3rd newsletter from this Canadian research group, who are undertaking some interesting research and development work on ehealth applications in British Columbia, which are worthy of a wider audience.

I noticed on their web site a poll about the formation of an independent body in Canada to certify Health Informaticians as Qualified Professionals along the lines that UKCHIP has established in the UK - perhaps this will become an accepted part of the health professional landscape?

About

Eclectic news and views on health informatics and elearning, by Rod Ward & colleagues. UK bias but worldwide coverage.
If you want to join the membership so that you can post comments - just let me know rod@rodspace.co.ukReturn to lastest posts